and F are based upon population projections which assume mortality declining at the 1955-1965 rate and natality declining at a more rapid rate than 1955-1965, largely as a result of organized efforts during 1965-1985. Requirements C and F are also based upon assumptions regarding additional requirements for health services when natality control is included.
Neither of these two important assumptions—the additional requirements for health services when family planning is included or the reduction in natality rate resulting from natality control—can be made with precision in the present state of knowledge, but rough guidelines are possible for planning purposes in individual countries.
HEALTH SERVICES REQUIREMENTS FOR FAMILY PLANNING
Semantics can be confusing here. As stated earlier, family planning programs and costs can be considered health service programs and costs. They can also be considered separately and will be so treated here to simplify understanding of alternatives. However, since they utilize some health manpower and facilities, account must be taken of specific health manpower and facilities that must be provided for family planning in addition to that already planned for other health purposes.
If we ignore the possibility that by 1985 technologic advance will make present requirements obsolete, we can reasonably estimate health service requirements for family planning by using available program experience in the world to date.
The requirements for doctors, nurses, and midwives that family planning service will add will depend largely upon decisions made in each country on what specific functions with regard to each method of contraception must be performed by a doctor or nurse or midwife, as well as on the actual availability and utilization rate for various methods. The requirement for doctors for intra-uterine contraception or for oral contraception will be low if most functions are performed by nurses or specially trained assistants and field workers, whereas using present techniques for induced abortion and surgical sterilization may require appreciable amounts of doctor manpower. In summary, much of the manpower required for family planning can be new, specially trained manpower—which will not significantly affect the planned requirements for doctors, nurses, and midwives for other health services.
Pakistan provides one example of an approach to family planning manpower requirements that places minimal strain on the limited medical manpower pool. Convinced that certain functions usually reserved for female doctors (such as pelvic examinations and intra-uterine contraceptive device insertions) could be performed by female high school graduates with one year of specialized training, program leaders established a new cadre of workers— "lady family planning visitors." As a result the program, as projected to 1975